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Clinical and epidemiological aspects of invasive Streptococcus pyogenes during one year

Abstract number: R2215

Unzaga M.J., Martin Y., Suarez M.D., Ezpeleta C., Alava J.A., Cisterna R.

Objective: The aim of this study was to improve understanding of the epidemiology of invasive group A streptococcal (GAS) disease.

Material and Methods: We realised a retrospective study of GAS isolates recovered from hospitalised patients with invasive disease. The isolates were sent to Carlos III Institute to typing procedures.

Results: There were 21 patients: 11 males (52.4%). The median and the mean age of patients were 40 years (range 0 to 77) and 38.47 years, respectively, with no important differences between male (40.27 mean) and females (36.5). The incidence was increased with low age range: <20 y. (33.3%), 20–50 y. (33.3%), 50–70 (9.6%) and >70 (23.8%).

The majority of isolates were recovered from blood (52.4%); skin, soft tissue infections (33.3%) and arthritis joint (4.8%) and other normal sterile sites. Skin and soft infections accounted for 52.4% of the cases (n = 11), arthritis (4.8%) (n = 1) and primary bacteraemia with no focal symptoms (28, 6%) (n = 6). 16 patients have at least one risk factor of which neoplasia accounted in n = 5, diabetes n = 3, previous traumatism n = 3, and previous surgery in n = 1. The mean case fatality rate was only a case 4.8% a woman 73 years old. Were admitted to intensive care 2 (9.5%) patients and underwent surgical intervention 3 (14.3%) patients as a part of the treatment.

Type distribution of GAS A broad range of emm types was recorded with the most common types being types, 1 (26.3%), 22 (10.5%), 3(10.5%), and 89 (10.5%). All emm 1 isolates (5) were T1, the emm 3 (2) were T3 type the emm 89 (2) T B3262 and the emm 6 (1) were T 6.

Skin and soft tissue infections were caused by emm 1, and emm 89 (20%) and 11, 22, 3, 5, 50, 6 (10%). Septicaemia isolates evenly distributed emm 1, 3, 4, 6, 77 and 87 (10%).

The cluster genes A/B/F/G/J/Z and B/C/F/G were detected in 21.1% and 15.8% of the isolates. Skin and soft infections were associated in 30% with the cluster B/C/F/G. Among the 21 strains 71.4%, (5) were speA positive and speC negative and 71.4% (10) were speC positive and speA negative. Positive speA and speC were 28.6% (2).

The rate of erythromycin-clindamycin resistance was 5%. This strain was emm 11, T11 and the B/C/F/G/H cluster gene.

Conclusions: The incidence of GAS was in the group of age <50 years and a smaller peak >70 years. Skin and soft tissue infections accounted 52.4%. A low level of macrolide resistance has been detected in this group. emm type 1 and 89 accounted for the highest percentage of invasive disease.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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